Report of a Fatal Purulent Pericarditis Case Caused by ST11-K64 Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae

Abstract

The report describes a 44-year-old female patient who died of the rare acute purulent pericarditis caused by Klebsiella pneumoniae (KP). The genomic analysis revealed an extensively drug-resistant ST11-K64 KP strain from five isolates (blood cultures, urine, ascites, pericardial effusion, and sputum). Several high virulence (hv) and carbapenem-resistant (CR) genes were identified in the pericardial effuse isolate. The isolates showed low resistance to healthy human serum. This study highlights the potential lethality of CR-hvKP infections in patients suffering from underlying comorbidities such as diabetes mellitus and chronic ailments.

Molecular Profiling of a Multi-Strain Hypervirulent Klebsiella pneumoniae Infection Within a Single Patient

“…Infections caused by simultaneously carbapenemase-producing and hypervirulent Klebsiella pneumoniae (CR-hvKP) are often lethal, as evidenced by our previous clinical experience 3 and the present study. The mortality rate is as high as 50% around the world.…”

“…1 Community-acquired or nosocomial KP has emerged as one of the principal pathogens of infectious diseases including pneumonia, urinary tract infections, sepsis, liver abscesses, purulent pericarditis, and wound site infections. [2][3][4] Decades of extensive use of antimicrobials has facilitated the rapid evolvement and dissemination of KP that produces extended-spectrum ß-lactamases (ESBLs) and carbapenemases (KPCs). These are enzymes that break down the entire last line of weapons against infectious diseases, by hydrolysing ß-lactams, fluoroquinolones and aminoglycosides, as well as penicillins, cephalosporins and monobactams, etc.…”

“…While the elderly people and hosts with comorbidities such as immunosuppression, diabetes mellitus and chronic renal insufficiency are at a greater risk for severe, sometimes even fatal infection of cKP, hvKP infection significantly affects younger and otherwise healthy population. 3 Infections with hvKP are more often emanated from community exposure, bearing a high geographical variation (higher in Taiwan and China than in western countries and Europe). 8 Besides, hvKP more likely possesses elevated iron acquisition systems and causes more metastatic phenotypes including multiple-site infection and debilitating syndromes.…”

“…14 CR-hvKP has been relentlessly impoverishing our last resort of antimicrobials and is showing an alarming trend to disseminate from Asian pacific rim to the whole globe to cause intractable infections in individuals of all ages. 3,10 While an accurate prevalence of CR-hvKP as an infectious agent is hard to measure, due to the lack of standardised diagnostic markers, devastating regional outbreaks of CR-hvKP in healthcare facilities have been reported around the world. [15][16][17][18][19][20] In particular, CR-hvKP is a major cause for ventilator-associated pneumonia, with a very high mortality rate.…”

“…22 The pathogenic colonization of KP in some cases and some period of infection can be occult and asymptomatic, which heavily compounds the tracking of its inter-or intra-patient evolution and spread. 3,19 Using whole-genome sequencing, researchers were able to chart a putative transmission map of multidrug-resistant KPs within a hospital environment and pin down the index patient who was discharged three weeks prior to the stealthily developed outbreak. 19 However, how various KP strains interact and adapt to survive along the course of the infection within a single host is not much understood.…”